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The price of inaction

Ray Collins and Michael Cashman on the gaps emerging in the UK government’s support for the global fight against HIV/AIDS

Today, as we mark World AIDs Day, the focus in the UK is quite rightly on those most at risk of infection, in particular men who have sex with men. Globally however, the startling situation is that women and girls are disproportionately affected by HIV, with 1000 new infections among adolescent girls every day. AIDS is also the leading cause of death for women of reproductive age; and the biggest killer of adolescent girls in Africa.

Despite huge progress over the past three decades with 15 million people on treatment, the number of women and girls living with HIV continues to increase. Poverty and a lack of economic empowerment contribute to this, leading to dependence on men, lack of access to education, sexual exploitation, engagement in informal and commercial sex work, harmful gender norms, and poor and unequal participation in public life.

But the most important policy to put in place is to enable women to be in charge of their own lives, to make decisions and not always be on the end of someone's largesse or hand-outs.

The UK – under different governments – has a strong record in tackling gender inequality. Indeed, DfID’s Strategic Vision for Girls and Women outlining four areas where getting results could be enhanced: first pregnancies and safe childbirth, economic assets, secondary education school, and preventing violence. Combined, these can help drive down HIV infection. Whilst there is no specific mention or action on HIV, DfID did suggest in 2013 that it hoped to strengthen its focus on women and girls affected through increasing integration of HIV with health and broader development priorities. To date however, that does not appear to be happening.

One of the dangers of ‘mainstreaming’ an issue into other sectors is that it can often receive less focus. Reaching the 2030 target of ending AIDS as a public health threat needs greater global resourcing. The government should be giving clear reassurances that it will not reduce support for its HIV-specific DfID programmes. A number of policy developments however, are placing key populations at risk.

One such concern relates to the reduction in bilateral HIV programmes in ‘middle income’ countries during the past five years. It is understandable of course, that the UK is prioritising action for those with the highest burden and least able to pay. But we have used GDP as the main criteria for deciding our focus – something globally recognised as too blunt an indicator to accurately ascertain whether a country can itself fill the gap left by departing donors. Plus the ending of these programmes has often been done without a meaningful transition plan for sustainability.

One example of this is Vietnam, where the UK was the key funder of a programme for injecting drug users; and where on leaving, the government did not ensure its continuity. It is vital therefore that we apply a broader and more nuanced set of criteria and utilise a wide range of support. If we are to see the end of the AIDS/HIV epidemic we must be consistent and thorough in our approach, and good early intervention should not be wasted once we move on.

Lord Ray Collins of Highbury and Lord Michael Cashman are Labour Peers in the House of Lords